Enrollment in plans on Arkansas’ health-insurance exchange among those who do not qualify for Medicaid reached 12,763 as of Dec. 28, up from 1,404 at the end of November, according to figures released Monday by the U.S. Department of Health and Human Services.
Providing demographic information for the first time since the enrollment began on Oct. 1, the figures also show that 40 percent of those who have signed up in Arkansas are ages 55 to 64, the age group not quite old enough to qualify for coverage under the federal Medicare program.
Only 18 percent of Arkansas’ enrollees were ages 18 to 34.
Nationally, 33 percent of the nearly 2.2 million people signing up by the end of December were ages 55 to 64, while just 24 percent were ages 18 to 34.
During a conference call with reporters on Monday, Mike Hash, director of the Health and Human Services Department’s office of health reform, said the demographic information shows an “appropriate mix in the marketplace” half-way through the enrollment period that extends through March 31.
Nancy Delew, acting deputy assistant secretary for planning and evaluation, said during the call, “We expected older adults to sign up early, and we expect more young adults to come in by the end of the open enrollment period.”
The same pattern was seen in Massachusetts during that state’s health-care overhaul in 2006, she said.
According to a report last month by the Menlo Park, Calif.-based Kaiser Family Foundation, people ages 18 to 34 make up 40 percent of the potential market of 28.6 million customers nationwide for plans on the insurance exchanges, while those ages 55 or older make up just 17 percent.
Older people typically have higher medical costs than younger people, but the health-care law limits how much more insurance companies can charge older people to account for that difference.
For that reason, a larger-than-expected enrollment among older people than younger people could mean higher premiums in future years.
Because premiums still vary by age, however, the Kaiser Family Foundation report found that higher than expected enrollment among older people, in itself, would have a modest affect.
For instance, if 25 percent of the enrollees were ages 18 to 24, the medical costs for the insurance plans would be about 2.4 percent higher than revenue, the report found.
Health and Human Services Secretary Kathleen Sebelius noted Monday that the total of 1.8 million people who signed up in December was nearly five times the combined enrollment in October and November, when software glitches and other problems prevented many people from being able to use the federal enrollment portal, healthcare.gov.
“We’re seeing a very strong response to the marketplace,” Sebelius said.
Arkansas Surgeon General Joe Thompson said the numbers show that many of the technical problems that prevented enrollment in October and November have been fixed.
“What’s obviously happening now is, the pipes have thawed and the water is flowing again, and we’ve got to get people to go and sign up if they want to have health insurance coverage.”
In addition to providing information about the age of the enrollees, the figures released Monday show that 56 percent of those who signed up in Arkansas are women, compared with 54 percent nationally.
The numbers also show that 88 percent of those signing up in Arkansas, and 79 percent of enrollees nationally, qualified for tax-credit assistance to help pay their premiums.
The subsidies are available to those who have incomes of less than 400 percent of the poverty level - $45,960 for an individual or $94,200 for a family of four - and who do not have access to a employer-sponsored plan that is considered “affordable,” meaning that it would cost less than 9.5 percent of the person’s income.
Most of those who signed up - 63 percent in Arkansas, and 60 percent nationally - chose a silver-level plan, designed to cover 70 percent of the average patient’s expenses.
That plan is the only one through which enrollees with incomes below 250 percent of the poverty level can receive additional subsidies that help reduce out-of-pocket expenses for medical care.
The next most popular choice in Arkansas were gold plans, which have higher premiums but cover 80 percentof a typical patient’s medical costs. According to the figures released Monday, 21 percent of the enrollees in Arkansas, and 13 percent of enrollees nationally, signed up for a gold plan.
Only 16 percent of Arkansas’ enrollees chose a low-premium bronze plan, designed to cover 60 percent of medical expenses. Nationally, 20 percent of enrollees chose a bronze plan.
Just 1 percent of enrollees nationally, and no one in Arkansas, chose a bare-bones, catastrophic-coverage plan. Those plans offer less coverage than bronze plans, and people who sign up for them are not eligible for subsidies.
Nationally, 7 percent of enrollees signed up for a platinum plan, designed to cover 90 percent of expenses. No company in Arkansas is offering a platinum plan on the exchange.
The numbers released Monday do not include enrollment in bronze, silver, gold, platinum or catastrophic coverage plans sold directly by insurers outside the exchanges.
The tax-credit subsidies cannot be used for plans purchased outside the exchanges, but the plans are included in the same risk pool used to calculate premiums as plans sold on the exchanges.
In Arkansas, a spokesman for Arkansas Blue Cross and Blue Shield has said that 6,100 people signed up by late December in plans offered on the exchange by the company or its national affiliate, while 2,500 people signed up directly with Arkansas Blue Cross in plans outside the exchange.
A spokesman for Qual-Choice Health Insurance said about 1,100 people signed up for plans with that company on the exchange, and fewer than 100 signed up outside the exchange.
A spokesman for St. Louis-based Centene Corp., which is also offering plans on Arkansas’ exchange, didn’t return calls seeking comment.
The risk pools in Arkansas also include more than 68,000 people for whom the state’s Medicaid program is buying insurance on the exchange under the expansion of the Medicaid program approved by the Legislature last year.
The expansion extended eligibility for coverage under the program to adults with incomes of up to 138 percent of the poverty level - $15,860 for an individual or $32,500 for a family of four.
About 10 percent of those who qualify for the expanded Medicaid program will be assigned to the traditional fee for service program, rather than the private plans, because they are considered to have exceptional health needs.
Thompson said the population enrolling in the Medicaid-funded plans is expected to have a younger age than the general population and will “end up stabilizing the risk pool.”
The state Department of Human Services had not released demographic information about the Medicaid enrollees as of Monday.
Arkansas Insurance Department spokesman Heather Haywood said the department’s 480 outreach workers, hired under contracts with other government agencies, nonprofits and private companies, will continue their efforts through March to tell people about the options that are available and help them sign up.
In late November, the department also unveiled a redesigned Web page for its Health Connector Division, at ahc.arkansas.gov, and has been updating it with information for consumers.
The department had planned a $4.5 million marketing effort, including television ads, billboards and other advertising, but that plan was scrapped after a legislative panel in September refused to review an extension of the department’s contract with a Little Rock advertising firm.
The initial, $4.3 million phase of the contract covered marketing efforts through Sept. 30.
“Right now, we’re solely relying on grass-roots efforts,” Haywood said.
Front Section, Pages 1 on 01/14/2014